Amg-Crockett, LLC
Organization Active NPI Neurology Physician · Lawrenceburg, TN
NPI 1043475700 · NPPES record last updated May 29, 2012
Key facts
- NPI
- 1043475700
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurology Physician 2084N0400X
- License
- 38839 (TN)
- Legal business name
- AMG-CROCKETT, LLC
- Practice address
- 1605 S Locust Ave
Suite 103
Lawrenceburg, TN 38464-4053 - Phone
- (931) 762-6571
- Fax
- (931) 762-3339
- NPI assigned
- Jul 22, 2008
- Organization subpart
- No
Authorized official
- Name
- Michael Clark
- Title
- Division President
- Phone
- (615) 372-8500
Other NPIs on the same Medicare enrollment 20
Practitioners 1
-
Norman Lin McNulty, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071017000313 | TN | Part B Supplier - Clinic/Group Practice | 4789770199 |
Receives reassigned benefits from 92 practitioners 20 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lawrenceburg, TN; Winchester, TN; Pulaski, TN; Mt Pleasant, TN; Loretto, TN; Decherd, TN |
National Provider Directory
Locations
1605 S Locust Ave
Ste 103
Lawrenceburg, TN 38464
Phone (931) 762-4551
4955 Highway 43 N
#1
Mount Pleasant, TN 38474
1255 E College St
Ste 300
Pulaski, TN 38478
Phone (615) 771-6899
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician |
2084N0400X | 38839 | TN | Yes |
Addresses
Primary practice location
1605 S Locust Ave
Suite 103
Lawrenceburg, TN 38464-4053
Mailing address
PO Box 248
Lawrenceburg, TN 38464-0248
Phone (931) 762-6571
Other names
- ADVANCED NEUROLOGY ASSOCIATES
Other providers in Lawrenceburg, TN
- Amg Crockett LLC
- Amg Crockett LLC
- Amg Crockett, LLC
- Amg Crockett, LLC
- Amg-Crockett, LLC
- Amg-Crockett, LLC
- Amg-Crockett, LLC
- Amg-Crockett, LLC
- Amg-Crockett, LLC
- Amg-Crockett, LLC
All providers in Lawrenceburg, TN · Neurology Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.